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Considerations in Last Mile Delivery in Access to Medicines – the ColaLife Story

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Considerations in Last Mile Delivery in Access to Medicines
Out of the box thinking and partnership – the ColaLife Story.

This presentation was given at the 'Access to Medicines' conference hosted by Takeda in Geneva on 25-May-17. It describes how access to diarrhoea treatment was transformed in Zambia.

Diarrhoea is the second biggest infectious killer of under 5 children and yet we know how to treat diarrhoea and the medicine is simple, safe and cheap. The problem is that 99% of diarrhoea cases do not receive the recommended treatment: ORS and Zinc. The last remaining barrier is access.

Published in: Health & Medicine
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Considerations in Last Mile Delivery in Access to Medicines – the ColaLife Story

  1. 1. Considerations in Last Mile Delivery in Access to Medicines Out of the box thinking and partnership – the ColaLife Story Simon Berry Co-founder & CEO, ColaLife simon@colalife.org
  2. 2. What is ColaLife? ColaLife is a charity registered in the UK Charity number: 1142516 – Two full-time workers and one part-time – Five voluntary trustees – Focus on saving children’s lives – Independent – Most of our work to date has been in Zambia – We are not looking to grow but – We are looking to have a global impact through • Disruptive innovation • Establishing national smart partnerships • Freely sharing findings and learning We have no commercial interest in the products described in this presentation
  3. 3. Rohit Ramchandani Jane Berry Simon Berry The Team.
  4. 4. Focus of our work – Zambia.
  5. 5. the problem
  6. 6. Diarrhoea 19%of infectious disease deaths Malaria 15%of infectious disease deaths AIDS 4% Source: Liu et al (2015) Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. The Lancet. 2nd biggest killer is diarrhoea.
  7. 7. 40% of children are stunted.
  8. 8. The decades old standard treatment that 99% children don’t get. ORS and Zinc
  9. 9. the innovation (#1)
  10. 10. Coke gets everywhere.
  11. 11. Remote rural retail shop, Kalomo District, Zambia Drug store room, Tiriri Health Centre, Katine, Uganda Medicines don’t
  12. 12. Finding out what people want. (not what you think they need) What we learnt Litre ORS sachets are too big Measuring water was an issue Willingness to pay Preferred branding 2010 2011 2012 2013 2014 2015 2016 201720091985
  13. 13. The product: Kit Yamoyo.
  14. 14. Kit Yamoyo brand, design & benefits. Kit Yamoyo • Attractive
  15. 15. Kit Yamoyo brand, design & benefits. Kit Yamoyo • Attractive • ORS sachets are 200ml
  16. 16. Kit Yamoyo brand, design & benefits. Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also: – A measuring device for the water
  17. 17. Kit Yamoyo brand, design & benefits. Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also: – A measuring device for the water – A mixing device
  18. 18. Kit Yamoyo brand, design & benefits. Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also: – A measuring device for the water – A mixing device – A storage device (the soap tray is a lid) – A cup
  19. 19. our approach (smart partnerships)
  20. 20. Everything we do must be self-sustaining… We cannot become a permanent part of the solution Everything is done through local organisations/processes We choose to work through partnerships WARNING! These must be *smart* partnerships Our approach.
  21. 21. Smart partnerships.
  22. 22. Smart partnerships (we are the strings).
  23. 23. the trial (establishing the evidence base)
  24. 24. 60% Only 60% of carers mixed ORS correctly when given conventional litre sachets. 0 Suppliers sold ORS or Zinc in the private sector. <1% of children received the correct treatment for diarrhoea – ORS & Zinc 7.3km Average distance to ORS at clinics (1 L sachet only, no Zinc). >26k Kit Yamoyos sold into 2 remote rural areas in 1 year via existing market channels. 45% of children in trial areas received ORS/Zinc. Up from a baseline of <1%. 2.4km Distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km. 93% of Kit Yamoyo users mixed ORS correctly, due to appropriate 200ml sachets and the kit’s measuring function. August 2013 After 12 months’ trial of new Kit Yamoyo design & distribution through existing private sector channels. September 2012 Before Kit Yamoyo. Rural, remote areas. Before After 2010 2011 2012 2013 2014 2015 2016 201720091985 Trial results.
  25. 25. The vision.
  26. 26. Kit Yamoyo v2 2010 2011 2012 2013 2014 2015 2016 201720091985 The reality.
  27. 27. Manufacture Assembly Distribution Wholesale K3.10 Retail K3.70 Customer K5.00 The Value Chain.
  28. 28. The awards: trophies not millstones; kudos not baggage.
  29. 29. “The main thing is to keep the main thing the main thing” Stephen Covey
  30. 30. the re-think (#1)
  31. 31. ORS Reduce number of sachets to 4 This may also enhance adherence to the combined therapy Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime Blister pack needs no box Soap Produce locally Leaflet Simplify – single fold. Same leaflet for all formats Packaging Remove constraint of fitting in Coca-Cola crate Produce locally Produce re-fill option v2 2010 2011 2012 2013 2014 2015 2016 201720091985 Incorporating the learning into the scale-up.
  32. 32. The flexi-pack The screw-top v2 2010 2011 2012 2013 2014 2015 2016 201720091985
  33. 33. The Kit Yamoyo bag can be used to measure the correct amount of water.
  34. 34. v2 2010 2011 2012 2013 2014 2015 2016 201720091985 Simple in-country campaign messages.
  35. 35. 452,000 kits to 11 of the SUN Districts v2 2010 2011 2012 2013 2014 2015 2016 201720091985 Government ORS/Zinc co-pack.
  36. 36. Kit Yamoyo production line.
  37. 37. v2 2010 2011 2012 2013 2014 2015 2016 201720091985
  38. 38. the re-think (#2)
  39. 39. The VAT issue response: Kit Yamoyo ESSENTIAL.
  40. 40. -19% $0.75 $0.93
  41. 41. the re-think (#3)
  42. 42. v2 2010 2011 2012 2013 2014 2015 2016 201720091985 The screw-top finally hit supermarket shelves.
  43. 43. 2016 sales
  44. 44. 2,602 18,195 7,227 351,950 Total 379,974 1,400 per working day in 2016 Discontinued from Oct-16 Introduced from Oct-15 Introduced from Oct-16 Supplied to MoH from Sep-15 to Dec-16 68,629 22,386 7,227 452,050 Total 550,292 Since Aug-12 2016 ex-factory sales.
  45. 45. Today's date: 01/12/16 Dataset date: 30/11/16 Release 7.1 Contact progress If the red segments in these pie charts match the red section of the large pie chart to the left then we are on target to contact all retailers in the current month. The orange segment represents the percentage of successful contacts (the green sector above) that were face to face (rather than by phone). The target is 50% face to face in Lusaka, 100% in other districts. Number of trained retailers: 1,302 Mumbwa: 83, Chipata: 161, Eastern: 138 Chirundu: 80, Kafue: 108, Lusaka: 528, Chilanga: 32 Kalabo: 63, Mongu: 109 Point of sale materials Percentage of retailers contacted with a Poster (P), Display Tray (D), Wall Painting (W) and no POS materials (N). Target: P=80%, D=80%, W=40% (Lusaka only), N=0% Wholesale & retail prices by district/province Province Wholesale Retail Central - Mumbwa 9.81 13.50 Eastern - Chipata 9.44 14.33 Eastern - Other 10.03 14.82 Lusaka - Chirundu 9.69 14.99 Lusaka - Kafue 8.79 14.59 Lusaka - Lusaka 9.36 15.20 Lusaka - Chilanga 8.86 14.63 Western - Kalabo 5.56 12.00 Western - Mongu 7.15 14.72 KYTS Management Dashboard 100% Percentage of current month elapsed Elapsed Remaining TARGET TARGET 29% Western - Mongu Number contacted Number aXempted No aXempt 47% Central - Mumbwa 47% Eastern - Chipata 16% Eastern - Other 100% Lusaka - Chirundu 56% Lusaka - Kafue 34% Lusaka - Lusaka 59% Lusaka - Chilanga 18% Western - Kalabo 100% 62% 18% 100% 100% 98% 100% 91% 100% Visit Phone 2.31 0.64 1.23 0.91 0.97 2.56 1.05 0.82 1.44 0 2 4 Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu Average kits sold (including zero sales) in the last 7 days and number in sample (number in sample equals number contacted) TARGET 1 13.50 14.33 14.82 14.99 14.59 15.20 14.63 12.00 14.72 0 2 4 6 8 10 12 14 16 18 20 Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu Average wholesale and retail prices by province and number in sample (number in sample equals number with retail sales) Avg retail price Avg wholesale price 2 3.08 2.33 3.18 3.67 1.38 2.46 1.53 1.00 3.03 0 1 2 3 4 5 6 Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu Average stock level (including zero stocks) and number in sample (number in sample excludes retailers ac_ng as wholesalers) TARGET 3 84% 62% 52% 67% 67% 64% 74% 40% 55% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu Percentage with stock and number in sample (number in sample equals number contacted) TARGET 4 77% 39% 50% 50% 67% 47% 74% 45% 50% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu Percentage of retailers contacted this month with sales in the last 7 days TARGET 5 82 0 5 18 P D W N 84 68 1 8 P D W N 94 89 0 6 P D W N 82 90 0 2 P D W N 99 94 24 1 P D W N 95 95 0 5 P D W N 100 100 0 0 P D W N 100 100 0 0 P D W N 97 90 3 0 P D W N Scale-up dashboards – colalife.org/dashboards.
  46. 46. key lessons
  47. 47. Foster innovation Prioritise innovation around access to medicines Fail fast, learn and move on Focus on want not need Make your partnerships smart Key Lessons.
  48. 48. Isenberg Family Charitable Foundation Thank you to the ColaLife funders past and present.

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